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Surgical Solution for Morbid Obesity
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Factors to Consider

1. How much weight do I need to lose?

You can expect to lose different amounts of your excess weight depending on the type of surgery you select. With a band you can lose between 30-60 per cent of your excess weight and with a bypass it is at least 70 per cent of excess weight. If your Body Mass Index (BMI) greater than 50, you will have more weight to lose therefore you maybe better off with a bypass.

For example:

Start weight: 130kg (BMI 50)
Ideal weight (BMI 25): 64kg
Excess body weight: 66kg

Bypass (lose 70 per cent excess weight): Lose 46kg
New weight 84kg (BMI 32)

Band (lose average of 45 per cent excess weight): Lose 30kg
New weight 100kg (BMI 39)

2. How quickly do I need to lose weight?

This is also worth considering and the different types of surgery also make you lose weight over different time periods. With the bypass the weight loss is rapid, where most is lost within the first 6-12 months. After this it slows down. With a band there is a more steady weight loss over years, where you can expect to lose between 0.5-1kg/week.

3. What other health problems do I have?

If you have other health problems linked to your weight such as diabetes, high cholesterol or high blood pressure, losing weight with surgery will help improve them. A bypass has a higher success rate in curing diabetes and maybe more suitable.

4. Am I planning to get pregnant?

It is not advisable to get pregnant when rapidly losing weight such as with the bypass. This is because your body may not be getting all the essential nutrients. It is advised that you should wait for at least 1-2 years following surgery. It should also be noted that with the weight loss your body becomes more fertile and therefore precautions need to be taken.

5. Does what I like to eat affect my choice of operation?

If you tend to eat lots of sweets and chocolates and find it hard to get control of this, you maybe more suited to a bypass. Many people with a bypass experience unpleasant side effects when eating sugary foods. This leads to actually avoiding the foods all together.

Do you like to eat fatty or fried foods? These foods are high in energy and make it hard to lose weight if eaten regularly. When taken with a bypass they could give you diarrhoea or loose stools, putting many people off eating them all together. If you continue to eat them with a band, even in small quantities, they can still slow down the weight loss.

6. What if I have problems with binge eating?

Surgery will not stop binge or emotional eating. Therefore it is best to get treatment for these problems before having surgery. A band may not be suitable if binge eating continues, due to its restrictive nature. Trying to over eat with a band will cause you to be sick. Repeatedly being sick must be avoided as it can cause damage to a band and further surgery could be needed.

7. Am I committed to work closely with the NLOSS team and attending regular hospital appointments?

It is important to attend regular hospital appointments after your surgery to ensure everything is going well and you are losing weight safely. If you choose a bypass, you will need to see the dietician and the doctor/nurse every three months. This is to make sure you are able to eat adequate nutrition. You will also need to have regular blood tests and vitamin injections.

8. Is surgery dangerous?

Patients are often worried about the complications of major surgery such as gastric bypass. It is true that a leak from one of the joins in the bowel is a major complication and can require a stay in hospital of two to three weeks where it occurs. If you are concerned about this, you may opt to choose the gastric band.

9. Is the procedure reversible?

Many people want a procedure that is reversible. If this is important to you, then the gastric band is the best choice here as it can be removed more easily. However, you should not go into the operation with the intention to have it undone in the future - if the band is removed then your weight is likely to return to what it was before surgery.

10. Will I need a further operation if things go wrong?

It is unlikely that a re-operation will be needed for either bypass and banding. However, generally with bypasses if you have not required one by the end of the first week then it is unlikely that you ever will. The opposite is true with bandings. Complications usually occur much later and are related to band slippage or erosion. Bands, like balloons, can also rupture.

11. Will my eating habits and lifestyle have to change after having surgery?

It is commonly thought that this surgery will force you to follow healthy eating patterns and lifestyle, but this isn't true. This surgery will help you to lose weight but it won't make it happen without your hard work and determination.

Both the gastric band and bypass restrict how much food you can take at one time helping you to limit food intake, thus lose weight. However, surgical treatment will not physically stop you from eating your favourite energy dense snack foods e.g. crisps, chocolates, biscuits, cakes etc. You will need to use your will power to stop eating these. Even in smaller quantities they will still provide your body with unwanted energy and fat, slowing down your weight loss.

Many people find that once they have had the surgery and the weight is coming off, they feel better within themselves and feel more motivated to exercise more and stick to a healthy diet.

Eating to help you cope with stressful and emotional situations is very common - if this is your case then you may not lose weight despite surgery! It is best to start making healthy lifestyle changes before surgery, as it is unlikely that the operation will make you change habits. To help you achieve this you can get support from psychiatrists specialising in eating disorder. They can assist you to obtain behaviour therapy before surgery.

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